Background: Emerging evidence indicates women who give birth in health facilities face humiliating and undignified conditions. Mistreatment can lead to avoidance and delays in seeking maternity care and can contribute to poor health outcomes. There is little evidence around how to measure mistreatment, implement approaches to mitigate it, and translate these findings into action.
Objectives: The objectives of three studies from East Africa were to: 1) measure prevalence of mistreatment reported by women post facility-based childbirth; 2) use qualitative methods to understand the drivers of disrespect and abuse; 3) based on the baseline findings, develop interventions to address mistreatment related to childbirth in health facilities; 4) determine the effectiveness of the intervention packages; and, 5) work to translate evidence into policy and practice.
Methods: The three studies (2 from Tanzania and 1 from Kenya) used quazi-experimental mixed-methods designs. Data included qualitative and quantitative base-line and end-line data, and intervention-implementation data to investigate how and why interventions were effective. Development partners provided 'research-to-use' capacity development and support throughout the process.
Results: Roughly 15-20% of study participants reported mistreatment; drivers ranged from socio-cultural, health system and individual factors. Multi-level, multi-component approaches with consultative processes are best positioned to promote respectful care and reduce mistreatment. Uptake of findings into national policy and programmes was facilitated by strategic stakeholder engagement and additional knowledge translation support.
Conclusion: Action is required at all levels to mitigate the mistreatment of women during childbirth. Countries like Tanzania and Kenya are examples of how implementation research findings can inform policies and programmes to advance respectful care. These examples underscore how implementation science partnerships with the appropriate mix of research, policy, advocacy and translation expertise have greater potential to disseminate and implement evidence.